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Dr. Seva Visceral GI

Dr. Seva's Visceral Pathology GIT

What are congenital esophageal problems? (3) 1. trachea-esophageal fistula 2. esophageal (Zenker's) diverticulum 3. esophageal web/ring
What is a trachea-esophageal fistula? A communiation b/w trachea and esophagus can give aspiration pneumonia in infant.
What is esophageal diverticulum? An outpouching in esophagus causes halitosis.
What is esophageal web/ring? A thickening of an area in esophagus that can cause a ringlike appearance; dysphagia; associated w/ iron deficiency anemia.
What do dysfunction of striated m. of upper esophagus, skeletal m. disorders, neuro. disorders and peripheral neuropathy cause? dysphagia: motor dysfunction of the esophagus = difficulty swallowing
What is achalasia? Impaired lower esophageal sphincter - failure to relax w/ absence of peristalsis in upper esophagus. Food is retained and esophageal dilation is proximal to LES.
What is achalasia associated with? Loss or absence of ganglion cells in the esophageal myenteric (Auerbach's) plexus; "rat tailed" or "beak" appearance in barium x-ray.
What is scleroderma of esophagus? Fibrosis in esophagus along w/ the dermis.
What is a hiatal hernia? Herniation of stomach through esophageal hiatus in the diaphragm.
What are the 2 types of hiatal hernia? Sliding hernia and paraesophageal hernia.
What is sliding hernia? Upward herniation of the gastric mucosa above the diaphragm
What is paraesophageal hernia? Upward herniation of the stomach by the side of esophagus.
What are clinical factors of hiatal hernia? heartburn, dysphagia, gastroesophageal reflex (GERD)
What is reflex esophagitis? Caused by regurgitation of gastric contents; "acid burn"
What agents decrease the pressure of the lower esophageal sphincter leading to GERD? alcohol, chocolate, fatty foods, cigarettes, pregnancy, estrogen therapy
What is candidal esophagitis? A fungal infection of esophagus found in immunocompromised patients like DM, HIV/AIDS, etc.
What are clinical factors of candidal esophagitis? dysphagia and odynophagia (painful swallowing)
What is chemical esophagitis? Occurs in accidental or intentional poisoning by lye or strong acids.
What is Barrett's esophagus? A result of chronic GE reflux normal strat. squamous epithelium of lower esophagus is replaced by columnar epithelium of the stomach (metaplasia). Can later form adenocarcinoma.
What are esophageal varices? Varicosity of esophageal veins at the lower third; dilated, congested veins thinner mucosa, blood in lumen, -> hematemesis.
What are esophageal varices related to? Hallmark of portal HTN and history of cirrhosis.
What is mallory weiss syndrome? Severe wretching at the GE junction associated w/ alcohol use; linear tear of esophagus at gastroesophageal junction.
What is diffuse esophageal spasm? Muscular thickening causes spasm - "rosary esophagus" or cork-screw esophagus in barium meal series.
What are tumors of esophagus? Benign: leiomyoma (uncommon); Malignant: squamous cell Ca worldwide but in US adenocarcinoma
What are risk factors for tumors of esophagus? smoking and alcohol for squamous cell carcinoma and barrette's esophagus for adenocarcinoma.
What are clinical features of tumors of the esophagus? dysphagia and cachexia
What is congenital pyloric stenosis and who is more likely to get it? Concentric enlargement of the pyloric sphincter and narrowing of the pylorus; more common in first born white male.
What is seen w/ congenital pyloric stenosis, what are clinical factors and treatment? Visible peristalsis fromleft to right and palpable olive-like mass in the abdomen; non-bilious projectile vomiting; surgery.
What is acute gastritis and what is it also called? Inflammation of the stomach; acute hemorrhagic (erosive) gastritis.
What causes acute gastritis? Drug (NSAID) and stress ulcers; occur in severely burned persons giving a curling ulcer in the mucosa of the stomach.
What are clinical features of acute gastritis? Vague abdominal discomfort or massive, life-threatening hemorrhage (coffee colored vomit) or clinical manifestations of gastric perforation (through all layers).
What are the 6 types of chronic gastritis? 1. Autoimmune atrophic gastritis 2. Environmental or multifocal atrophic gastritis 3. Helicobactor gastritis 4. Granulomatous gastritis 5. Chemical or reactive gastropathy 6. Menetrier DZ: hyperplastic hypersecretory gastropathy.
What is associated w/ autoimmune atrophic gastritis? Pernicious (megaloblastic) anemia which is caused by malabsorption of vitamin B12 d/t intrinsic factor deficiency.
What does autoimmune atrophic gastritis exhibit? 1. Diffuse atrophic gastritis in the body & fundus of the stomach 2. Antibodies to parietal cells & intrinsic factor 3. Reduced (hypochlorhydria) or absence of gastric secretion (achlorhydria) 4. G cell hyperplasia & increased serum gastrin (may -> Ca)
What is Environmental or multifocal atrophic gastritis? The stomach mucosa is replaced by intestinal mucosa. This metaplastic change is a risk factor for gastric adenocarcinoma. More risk for those w/ pernicious anemia and cancer is common in gastric antrum.
What causes environmental or multifocal atrophic gastritis and what is it associated w/? Unknown etiology; involves antrum; more common than autoimmune; associated w/ hypochlorhydria.
What is helicobactor gastritis associated w/? helicobactor pylori -> ulcer: pain, may bleed -> anemia
When diagnosing anemia what must be ruled out for males and females? Males: must r/o ulcer and prostate and colon cancer; Females: child bearing age r/o from anemia from cycle
What is granulomatous gastritis associated w/? TB, sarcoidosis, crohn's disease or idiopathic.
Who gets chemical or reactive gastropathy? Patients who use NSAIDs chronically; bleeding inside -> anemia and losing blood in feces.
What is a finding in menetrier disease: hyperplastic hypersecretory gastropathy? Gastric mucosa is characterized by enlarged brain like convolutions (rugae) and protein loss from altered gastric mucosa.
What are clinical features for menetrier disease? Postprandial pain w/ pedal edema, ascities & cachexia. Considered pre-cancerous.
What is peptic ulcer disease and where is it common? Focal mucosal destruction caused by the action of gastric secretions; Common in distal stomach and proximal duodenum.
Describe a person w/ a gastric ulcer. 25% of ulcers; common in elderly people; immediate pain after eating; more pain standing; blood in vomit; afraid to eat; thin
Describe a person w/ a duodenal ulcer. 75% of ulcers; common in young males; pain 1-2 hours after eating; more pain lying down; blood in fecal matter = melena (black/tar like); eat constantly, think pain from hunger; obese.
What are risk factors for peptic ulcers? cigarettes, NSAID, people w/ O blood type, epithelial injury by H. pylori
What are clinical features for peptic ulcers? Dyspepsia (indigestion), epigastric pain; hour glass and teapot stomach w/ barium meal studies.
What are complications of peptic ulcers? Hemorrhage, obstruction (d/t fibrous tissue), perforation, peritonitis.
What are benign and malignant neoplasms that appear in the stomach? Benign: tubular adenoma (uncommon); Malignant: gastric adenocarcinoma
What gives increased risk for gastric neoplasm? diet: nitrasamine; most common among people who eat large amounts of starch, smoked fish and meat and pickled vegetables; blood type A
What is seen macroscopically in gastric cancers (3 groups)? 1. Fungating mass (growth in fundus) 2. Malignant ulcer w/ raised everted edges 3. Diffused type - linitis plastica (stomach shrunk w/ thick wall)
What is seen microscopically in gastric cancers? All have signet ring cells (not Ca w/o)
What are clinical symptoms of gastric cancers? weight loss, anorexia, hematemesis, anemia, left clavicular lymph node enlargement (Virchow's node)
What are the 3 A's (symptoms) of GIT cancer? 1. Anorexia 2. Anemia 3. Asthemia (ill, tired)
What are tricobezoars? Foreign bodies (gum or hair) altered by the digestive process. Mass of hairball usually seen in long haired girls who eat their own hair as nervous habit.
What are congenital anomalies of small and large intestine? 1. Atresia 2. Stenosis 3. Mickel's diverticulum
What is atresia? Complete occlusion of (small) intestinal lumen
What is stenosis w/ intestinal congenital anomalies? Incomplete stricture which narrows but does not occlude the lumen.
What is Meckel's diverticulum w/ intestinal congenital anomalies? Outpouching of ileum d/t persistent vitelline duct. Mostly asymptomatic but may -> a number of complications: peptic ulceration, intestinal obstruction, diverticulitis, perforation and peritonitis.
What is enterocolitis? Small and large intestine inflammation; diarrhea: sudden onset of bowel frequency associated w/ abdominal cramp.
What is secretory diarrhea d/t? Cholera toxin, celiac disease, lactose intolerance, laxitives.
What is exudative diarrhea and what is it d/t? Blood and mucus in the stool; ulcerative colitis and Crohn's Dz.
What is hypermotility dirrhea? d/t increased motility: hyperthyroidism, diabetic neuropathy
What is inflammatory diarrhea? Damage to mucosal lining by bacteria, virus, etc.
What is dysentery? Not diarrhea but is visible in the stool d/t bowel tissue invasion from shigella and salmonella.
What is Pseudomembranous colitis? Antibiotic associated diarrhea: developed following the use of any antibiotic in the first few days. Causative organism is clostridium difficile.
What causes chronic diarrhea? Ulcerative colitis, chron's Dz, carcinoma of the colon; also a symptom in HIV patients.
What is intestinal ischemia and infarction? Decreased blood flow to the intestine d/t any cause (sup. mesenteric a. thrombosis or acute MI); may range from mucosal necrosis to transmural infarction.
What are clinical features of intestinal ischemia and infarction? Adynamic ileus (absence of peristalsis) may lead to peritonitis and sepsis (dead area of intestine gangrenous need surgery to remove), no bowel sounds, vomit constantly
What are the 3 types of malabsorption syndrome? Common symptoms: diarrhea and steatorrhea 1. Celiac sprue 2. Tropical sprue (postinfection sprue) 3. Whipple's Dz
What is celiac sprue? Damage to the small intestinal mucosa d/t abnormal senstivity to gluten. Microscopically: villous atrophy
What is tropical sprue? Common after visiting south east Asia or Caribbean; long standing contamination of bowel w/ e. coli, or associated w/ B12 and B9 deficiency. No villous atrophy.
What is Whipple's Dz? Lamina propria contains macrophages w/ the organisms; mucosal damage and lymphatic obstruction. Will also have fever and joint pain in addition to diarrhea.
What are the 2 idiopathic inflammatory bowel diseases? 1. Ulcerative colitis 2. Chrohn's Dz: regional ileitis
What is ulcerative colitis? chronic inflammation of the large intestine (rectum, sigmoid colon); continuous lesion and superficial inflammation (ulcers); colonoscopy shows inc. mucosal friability, thick inflam. exudates.
What symptoms are sen w/ ulcerative colitis? Recurrent hematochezia (fresh blood in feces) w/ pus/mucus; higher risk of colon adenocarcinoma.
What is Crohn's Dz: regional ileitis? Prevalent in young adults (20-40) and 2-3x more common in Jews; Chronic inflammation of small intestine (ileum)
What is seen in Crohn's Dz? Intermittent lesions and transmural inflammation; edematous mucosa presents "cobble-stone" appearance. Intestinal lumen narrows b/c edema and fibrosis and non-caseating granulomas.
What are symptoms and complications of Crohn's Dz? Severe abdominal pain, diarrhea and fever; intestinal obstruction and fistulas
What are 3 types of Bowel obstructions and diverticulosis? 1. Adhesions 2. Intussception 3. Volvulus
What is adhesions in bowel obstruction and diverticulosis? Post surgical adhesions (fibrous bands) b/w tissues/organs may cause small bowel obstruction and strangulations.
What is intussuception in bowel obstruction and diverticulosis? Telescoping one segment of the intestine into another segment like stacking glasses; common in children
What are the 4 cardinal effects of intussuception in bowel obstruction and diverticulosis? 1. Colicky abdominal pain 2. Vomiting 3. Currant jelly stools (mix of blood and mucus) 4. Tender, palpable sausage shaped abdominal mass.
What is volvulus in bowel obstruction and diverticulosis? Twisting of intestine at least 180 degrees on its mesetery, resulting in blood vessel compression and ischemia.
What are clinical features of volvulus in bowel obstruction and diverticulosis? vomiting and rapid, marked abdominal distension followed by sudden onset of severe abdominal pain.
What is appendicitis? common in young adults; appendix obstructed by fecalith (fecal stone)
What are clinical features of appendicitis? anorexia, nausea, vomiting, periumbilical pain (McBurney's poing), rebound tenderness, leukocytosis
What are complications of appendicitis? necrosis-gangrene-perforation-peritonitis
What is diverticulosis? Outpouching of mucus membrane of the intestine; common in sigmoid colon; aka left sided appendicitis
What causes diverticulosis? Decreased fiber in diet; if inflamed diverticulitis; pouch opp. of polyp.
What are clinical features, complications and x-ray findings of diverticulosis? Moderate left abdominal pain and vomiting; perforation, stricture, fibrosis; saw teeth appearance
What is polyps of colon and rectum? Mass that protrudes into lumen of the gut; can be benign or malignant; asymptomatic but some are precancerous
What is familial adenomatous polyposis? 1000 or more polyps in the colon; autosomal dominant; if colectomy not done all patients dev. adenocarcinoma of the colon by 40 y/o
What are benign tumors of the large intestine? tubular, villous or tubulovillous (MC) adenomas. Tubular (stalk and smooth surface) common in US; small flat adenomas may be missed in colonoscopy and have high chance becoming malignant; male predominance more in blacks; commonly in rectosigmoid region
What are risk factors of colorectal adenocarcinoma? Familial, high animal fat diet, low fiber diet, ulcerative colitis; diet associated w/ slower transit of fecal contents through the colon.
How does colorectal adenocarcinoma appear? As an ascending polypoid messes or nvolve the whole circumference ("apple core appearance") and constrict the lumen or ulcers w/ everted edges
What are clinical features of colorectal adenocarcinoma? Altered bowel habits, abdominal palpable mass, abdominal pain, weight loss, anemia, hemetochezia; Staging done by Duke's staging method.
What is cirrhosis of the liver and steps this pathology takes? End stage of chronic liver disease; 1. necrosis 2. fibrosis 3. Vascular destruction & derangement 4. Regenerative nodules 5. Destruction of normal liver architecture 6. Diffuse involvement of whole liver
What is the etiology of cirrhosis of the liver? alcohol, viral, biliary diseases, hemochromatosis; is irreversible, progressive and premalignant.
What are clinical features of cirrhosis of liver? Loss of functional liver parenchyma causes: hypoalbuminemia (-> edema, ascites), clotting abnormalities, jaundice, risk of infection, portal HTN, endocrine abnormalities, primary hepatocellular carcinoma
What is icterus? Jaundice; yellow discoloration of conjunctiva and mucosa membrane; hyperbilirubinemia & pruritus (itching).
What are the 3 types of jaundice? 1. Hemolytic J (pre-hepatic) 2. Hepatic J 3. Obstructice J (post-hepatic J)
What is hemolytic J? Hemolytic anemia. Increased bilirubin in serum but not in urine; urine color normal.
What is hepatic J? cirrhosis; Increased bilirubin in serum and bilirubin present in urine; dark urine.
What is Obstructive J? Cholestasis: e.g. gallbladder Dz; increased bilirubin in serum, dark urine; pale stool.
What is neonatal jaundice? Physiological J: mild jaundice from 2nd to 8th day after birth d/t result of immaturity of the liver enzyme system.
What is Kernicterus? Neonatal pathological jaundice; a severe neurological condition associated w/ very high levels of unconjugated bilirubin in the blood & brain causing cerebral dysfunction
What are clinical features of kernicterus? lethargy, convulsions, hearing loss, mental retardation.
What is Gilbert syndrome? an inherited, mild, chronic unconjugated hyperbilirubinemia that is d/t impaired clearance of bilirubin in the absence of any detectable functional or structural liver disease.
What is Dubin-Johnson syndrome? An inherited, mild, chronic conjugated hyperbilirubinemia that is caused aby impaired clearance of bilirubin w/ deposition of melanin like pigments in the liver (black-liver).
What are clinical features of Dubin-Johnson syndrome? Mild intermittent jaundice w/ dark urine.
What is Rotor syndrome? Familial conjugated hyperbilirubinemia but w/o liver pigments.
What is benign recurrent intrahepatic cholestasis? Familial; self-limited periodic episodes of malaise and itching d/t bile stasis in the bile canaliculi.
What is cholestasis of pregnancy? Characterized by pruritus & cholestatic jaundice during the last trimester of pregnancy which disappears after delivery.
What are complications of cholestasis of pregnancy? Fetal distress, prematurity or stillbirth
What is always associated with increased bile in the body? Pruritis
What is fulminant hepatitis? Hepatic encephalopathy. High levels of ammonia in the blood and brain, may die w/in a week.
What is autoimmune hepatitis? Idiopathic, chronic hepatitis w/ autoantibodies and increased serum immunoglobulins
What is primary sclerosing cholangitis? Idiopathic; chronic cond'n; inflammation and fibrosis narrows and eventually obstructs the bile duct
What is hereditary hemochromatosis? Excessive absorption and toxic accumulation of iron in hepatocytes, pancreas, joint cavities, heart and skin. Autosomal dominant.
What are clinical features of hereditary hemochromatosis? Will affect at least 3 of these tissues: Cirrhosis, cardiomegaly (d/t iron pigment), skin pigmentation (metallic brown), arthropathy and diabetes mellitus (secondary b/c iron in pancreas).
What is secondary hemochromatosis? In sickle cell anemia and thalassemia and dietary iron overload.
What is hepatolenticular disease: Wilson's Dz? Autosomal recessive; excessive copper deposition in liver and brain.
What are clinical features of Wilson's Dz? Jaundice, tremors, dysarthria, Kayser-Fleischer ring in the eyes and spontaneous bone fractures and osteoporosis.
What is and what causes hepatotoxicity? Drug induced liver Dz; acetaminophen, NSAID, some herbal remedies; natural or synthetic still goes through liver.
What is hepatic pyogenic abscess? high fever w/ right quadrant pain, rapid weight loss and hepatomegaly.
What are benign hepatic tumors? Hepatic Adenoma Hepatic Hemangiomas
What is hepatic adenoma? Common in women of reproductive age w/ oral contraceptive Hx; mostly solitary and sharply demarcated masses.
What is Hepatic hemangioma? Most common in young children. Asymptomatic or right hypochondrial pain. (BVs undergo benign changes)
What is the etiology of hepatocellular carcinoma? Hepatitis B & C, alcoholic dirrhosis and hemochromatosis
What are clinical features of hepatocellular carcinoma? Jaundice, painful hepatomegaly, cachexia
What is cholangiocarcinoma? Cancer arising from intrahepatic bile ducts.
What are clinical features of cholangiocarcinoma? In older adults, 60+ y/o; jaundice, weight loss, itching
What is hemangiosarcoma and the etiology? Multiple hemorrhagic nodules; exposure to vinyl chloride, inorganic arsenic
What are clinical features of hemangiosarcoma? Hepatomegaly, jaundice, ascites; secondary liver cancer normally from GIT -> many masses; secondary liver cancer more common than primary.
What is cholelithiasis? bile stone in duct (-lithiasis = stone) cholesterol in whites and pigment stones in other races.
How does one feel w/ gall stones and how are they seen? Asymptomatic and biliary colic (feel full, pain in muscular tube, not continuous, spasmodic); visible by ultrasound, not radiopaque.
What are the 5 F's of gall stones? Female Forty Fat Fertile (multiparous) Fair
What is the etiology of gall stones in white people? high cholesterol or decreased bile salts or decreased gall bladder motility for cholesterol stones
What is the etiology of gall stones for other races? sickle cell anemia and parasitic infestation
What is choledocholithiasis? Gall stones in the common bile duct?
What is acute cholecystitis? GB inflammation; edematous enlarged gall bladder
What are the etiology and s/s of cholecystitis? Cholelithiasis or bacterial; pain at Murphy's point radiating to right shoulder, fever w/ chills, leukocytosis.
What are complications of cholecystitis? Empyema bladder (filled w/ pus, chills, high fever), perforation and peritonitis
What is chronic cholecystitis? Persistent inflammation of gall bladder associated w/ gall stones or repeated attacks of acute cholecystitis; thick, firm and contracted gall bladder, the wall may become calcified (porcelain gall bladder)
What are symptoms of chronic cholecystitis? nonspecific vague abdominal symptoms.
What is a papilloma? Most common benign tumor of GB
What is cholangio adenocarcinoma? common in women, porcelain gall bladder is prone to become cancer of the gall bladder
What are the 2 main causes of pancreatic pathology? Alcohol or idiopathic
What is cystic fibrosis? Mucoviscidosis (thick mucus); a congenital disease, abnormal mucus secretion of the exocrine glands throughout the body.
What are s/s of cystic fibrosis/mucoviscidosis? Recurrent pulmonary infections and pancreatic insufficiency lead to failure to thrive (thinner, small for age)
What causes acute pancreatitis? Gall stones, alcohol, mumps (paramyxo virus)
What happens in acute pancreatitis? Pancreas releases its lytic enzymes causing necrosis of its own tissue and surrounding tissue
What are clinical features of acute pancreatitis? Sudden onset of severe boring abdominal pain, radiating to the back, nausea and vomiting. Cullen's sign, turner's sign; serum amylase greatly elevated -> hypotension and shock.
What is Cullen's sign? Subcutaneous (internal) bleeding around umbilicus
What is Turner's sign? Subcutaneous bleeding on back
What causes chronic pancreatitis? chronic alcoholism, gall stone, cystic fibrosis
How does chronic pancreatitis look? Shrinkage of pancreas d/t fibrosis and atrophy of the acinar structures.
What are clinical features of chronic pancreatitis? Steatorrhea, endocrine insufficiency
Describe carcinoma of the pancreas. adenocarcinoma w/ CFs of weight loss, midepigastric and back pain, jaundice w/ clay colored stool.
What is Zollinger Ellison's syndrome (Gastrinoma)? Malignant islet cell tumor from G cells produce excess of gastrin - hyper acidity and peptic ulcer Dz w/ clinical features of diarrhea and abdominal pain.
Created by: kabrown